Date of this Version

12-5-2024

Document Type

DNP Project

Abstract

Background Spinal anesthesia is classified as among the most reliable types of regional block methods. Multiple needle attempts result in complications, including post-dural puncture headache, spinal hematoma, permanent neurological damage, and neurological trauma. Some methods developed are landmark-assisted and ultrasonography-guided (USG) for neuraxial spinal anesthesia. The aim or objective is to implement the use of USG to help manage the technical difficulties with the placement of the spinal block among the elderly suffering from fractures and those with complex anatomies.

Method

The method is a quality improvement project that began with a comprehensive literature review comparing USG and landmark-assisted use for spinal anesthesia. This review was crucial in establishing the effectiveness of USG and providing a solid foundation for our project. The quality improvement adopted the quasi-experimental one-group, pre-/post-intervention design, where the interventional outcome of interest is measured two times before and after exposing the group to the intervention. An email was sent to the anesthesia providers to recruit the participants and confirm their inclusion in the QI project. A MEMO was placed on the notice boards of the surgical and emergency departments. Data was collected using the patient satisfaction survey rating the level of service they received. Numerical data were collected, including the technical difficulties involved, such as first-time insertions, and analyzed for pre- and post-intervention to determine if there have been any improvements.

Comments

Conclusion

This quality improvement project focused on implementing and evaluating an evidence based intervention that targeted education of anesthesia providers on the importance or effectiveness of USG over landmark-guided spinal anesthesia among elderly patients with complex anatomies and fractures. After the descriptive statistical analysis, the pre-test and post test responses from 20 anesthesia providers were analyzed to determine knowledge changes after the intervention. The results showed that the participants answered the knowledge questions on USG more correctly after the educational intervention, as demonstrated by the higher mean and lower standard deviation. The resources used in the intervention were found to be valuable for the anesthesia providers. The effectiveness of USG among elderly patients with fractures and complex anatomies was supported by the literature in the discussion section. However, the study could have been more extensive because of the participants' unavailability, resulting in a small sample size, data coding issues, and finding a reliable and valid scale for the questions.

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